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<title>Capital West Insurance Services - Surrey, BC</title>
<script language="JavaScript" src="js/util.js"></script>
<script language="javascript">
function validate(){
	
	var fieldName = new Array("name",
	"contactNo",
	"email","location"
	);

	var fieldMsg = new Array("Name",
	"Contact Number",
	"Email Address","Location"
	);
	
	for(var i=0; i<fieldName.length; i++){
		tmp = eval("document.getQuote."+fieldName[i]);
		if(trim(tmp.value) == ""){ //checks that field does not contain blank spaces
			alert(fieldMsg[i]+" Cannot be left Blank");
			tmp.value = "";
			tmp.focus();
			return false;
		}
	}

   //check to see that Password is minimum 4 chars
   if(isNaN(document.getQuote.contactNo.value) ){
	   alert("The Contact Number is Invalid");
	   document.getQuote.contactNo.focus();
   	   return false;
   }

   if(document.getQuote.contactNo.value.length < 4 ){
	   alert("The Contact Number should contain atleast 10 Numbers");
	   document.getQuote.contactNo.focus();
   	   return false;
   }
   
   //validates email address
   if(!emailCheck(document.getQuote.email.value)){
  	 document.getQuote.email.focus();
  	 return false;
   }
   
   return true;
}
</script>
<style type="text/css">
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.style1 {
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a:link {
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a:visited {
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a:hover {
	text-decoration: none;
	color: #A32960;
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<body>
<table width="760" height="100%"  border="0" align="center" cellpadding="0" cellspacing="0">
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    <td width="150" align="left" valign="top" bgcolor="#13133F"><img src="images/img_quote.jpg" width="150" height="100">
    <table width="150"  border="0" cellpadding="0" cellspacing="0">
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        <td><img src="images/lmenu_03.gif" width="150" height="7"></td>
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        <td><a href="aboutus.html"><img src="images/lmenu_04.gif" width="150" height="23" border="0"></a></td>
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        <td><img src="images/lmenu_05.gif" width="150" height="7"></td>
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        <td><a href="contactus.html"><img src="images/lmenu_06.gif" width="150" height="23" border="0"></a></td>
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        <td><img src="images/lmenu_09.gif" width="150" height="7"></td>
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        <td><a href="getQuote.html"><img src="images/lmenu_10.gif" width="150" height="65" border="0"></a></td>
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</td>
    <td width="610" align="center" valign="top" bgcolor="#FFFFFF"><table width="610"  border="0" cellpadding="0" cellspacing="0">
      <tr align="left" valign="top">
        <td width="124" height="25"><img src="images/corner1.gif" width="124" height="69"></td>
        <td width="92"><a href="auto.html" title="Auto Insurance"><img src="images/rmenu_1auto.gif" width="92" height="69" border="0"></a></td>
        <td width="97"><a href="home.html" title="Home Insurance"><img src="images/rmenu_2home.gif" width="97" height="69" border="0"></a></td>
        <td width="90"><a href="travel.html" title="Travel Insurance"><img src="images/rmenu_3travel.gif" width="90" height="69" border="0"></a></td>
        <td width="96"><a href="commercial.html" title="Commercial Insurance"><img src="images/rmenu_4traval.gif" width="96" height="69" border="0"></a></td>
        <td width="83"><a href="life.html" title="Life Insurance"><img src="images/rmenu_5life.gif" width="83" height="69" border="0"></a></td>
        <td width="28"><img src="images/spacer.gif" width="28" height="69"></td>
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  </tr>
    </table>
    <br>
    <table width="549"  border="0" cellspacing="0" cellpadding="0">
      <tr>
        <td width="549"><span class="style1">Request A Quote</span> <br>
        Please fill in the following details and an agent will contact you as promptly  as possible.<br>
        <br>
        <form name="getQuote" method="post" onSubmit="return validate()" action="http://www.capwest.ca/submitGetQuote.cfm">
		<table width="549"  border="0" cellspacing="0" cellpadding="2">
          <tr>
            <td colspan="3" align="center"><div align="left"><font color="#000000" size="1" face="Verdana, Arial, Helvetica, sans-serif">Note: </font><font color="#FF0000" size="1" face="Verdana, Arial, Helvetica, sans-serif">* <font color="#000000">Indicates mandatory Field</font></font></div></td>
            </tr>
          <tr>
            <td width="11" align="center">&nbsp;</td>
            <td width="139"><strong><font color="#FF0000" size="1" face="Verdana, Arial, Helvetica, sans-serif">*</font>Name</strong></td>
            <td width="387"><input name="name" type="text" id="name" maxlength="50"></td>
          </tr>
          <tr>
            <td align="center">&nbsp;</td>
            <td><strong><font color="#FF0000" size="1" face="Verdana, Arial, Helvetica, sans-serif">*</font>Contact No </strong></td>
            <td><input name="contactNo" type="text" id="contactNo" size="10" maxlength="50"></td>
          </tr>
          <tr>
            <td align="center">&nbsp;</td>
            <td valign="top"><strong>Address</strong></td>
            <td><textarea name="address" cols="25" rows="3" id="address"></textarea></td>
          </tr>
          <tr>
            <td align="center">&nbsp;</td>
            <td><strong><font color="#FF0000" size="1" face="Verdana, Arial, Helvetica, sans-serif">*</font>Email Address </strong></td>
            <td><input name="email" type="text" id="email" maxlength="60"></td>
          </tr>
          <tr>
            <td align="center">&nbsp;</td>
            <td><strong>You are looking For </strong></td>
            <td><select name="lookingFor" id="lookingFor">
              <option>Auto Insurance</option>
              <option>Home Insurance</option>
              <option>Travel Insurance</option>
              <option>Commercial Insurance</option>
              <option>Life Insurance</option>
            </select></td>
          </tr>
		    <tr>
            <td align="center">&nbsp;</td>
            <td><strong>Location Interested In </strong></td>
            <td><select name="location" id="location">
              <option>--Select--</option>
              <option value="info@capwest.ca">Surrey</option>
              <option value="capitalw@smartt.com">Langley</option>
              <option value="capwest@smartt.com">Maple Ridge</option>
              
            </select></td>
          </tr>
          <tr>
            <td align="center">&nbsp;</td>
            <td colspan="2"><strong> Additional Information</strong></td>
            </tr>
          <tr>
            <td align="center">&nbsp;</td>
            <td colspan="2"><textarea name="additionalInfo" cols="40" rows="4" id="additionalInfo"></textarea></td>
          </tr>
          <tr>
            <td align="center">&nbsp;</td>
            <td colspan="2"><input type="submit" name="Submit" value="Submit">
              &nbsp;
              <input type="reset" name="Reset" value="Reset"></td>
          </tr>
        </table>
		</form>
        <br>        </td>
      </tr>
    </table></td>
  </tr>
  <tr>
    <td height="35" colspan="2" align="left" valign="top">
<table  border="0" cellspacing="0" cellpadding="0">
  <tr>
    <td width="150" height="50" bgcolor="#13133F">&nbsp;</td>
    <td width="610" align="center" bgcolor="#FFFFFF">[<a href="auto.html">Auto Insurance</a>]&nbsp;&nbsp;[<a href="home.html">Home Insurance</a>]&nbsp;  [<a href="travel.html">Travel Insurance</a>]&nbsp;  [<a href="commercial.html">Commercial Insurance</a>]&nbsp;  [<a href="life.html">Life Insurance</a>] <br>
      <br>
    <a href="http://www.shiftonline.com/" target="_blank"><img src="images/pbso.gif" width="167" height="18" vspace="7" border="0"></a></td>
  </tr>
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    <td colspan="2"><img src="images/bot.gif" width="760" height="35"></td>
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</td>
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